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June 17, 2010 Volume VI, No. 55

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

New studies in this week's DM Update look at what's preventing cancer patients from seeking medical care and the racial disparities in asthma treatment.

We also examined what could have prevented the high hospitalization rates that Pennsylvania hospitals are experiencing and present just-published benchmarks in obesity and weight management.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Cancer Care Costs
  2. Racial Disparities in Asthma Care
  3. Kaiser Reduces ER Visits
  4. Improving Medical Home Care Delivery
  5. Power of Patient Education
  6. 2010 Benchmarks in Obesity, Weight Management
  7. DM & Hospitalization Rates
  8. HRAs

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Please send comments, questions and replies to jpapay@hin.com.

Publisher:
Melanie Matthews, mmatthews@hin.com

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Cost Concerns Prevent Cancer Survivors from Seeking Medical Care

A new study led by a Wake Forest University Baptist Medical Center researcher shows that 18 percent of cancer survivors — more than 2 million individuals — are forgoing needed medical care because of concerns about cost. The study raises the concern that the long-term health and well-being of cancer survivors could suffer because patients have financial worries about their care.

A team examined the prevalence of forgoing different types of healthcare due to financial concerns. Researchers sought to determine whether cancer history and race or ethnicity were associated with individuals’ likelihood to go without care. The investigators analyzed information from the annual U.S. National Health Interview Survey (NHIS). Data from 6,602 adult cancer survivors and 104,364 individuals with no history of cancer who were surveyed in the 2003 to 2006 NHIS were included in the study.

The analysis showed that among cancer survivors, the prevalence of forgoing care in the past year due to concerns about cost was 7.8 percent for medical care, 9.9 percent for prescription medications, 11.3 percent for dental care and 2.7 percent for mental healthcare. Cancer survivors under age 65 were one and a half to two times more likely to delay or forgo all types of medical care than their same-age peers without a history of cancer. Hispanic and black cancer survivors were more likely to go without prescription medications and dental care than white survivors.

To learn more about this research, please visit:
http://www.wfubmc.edu/News-Releases/2010/...

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Racial Disparities in Asthma Exist Among Children with Equal Access to Healthcare

Within a comprehensive health insurance system, black and Hispanic children appear more likely than white children to have asthma, and their outcomes are often worse, according to a new report from Mathematica Policy Research. Many factors contribute to well-documented racial and ethnic disparities in children's health and healthcare, according to the article. Universal healthcare coverage is widely considered an essential component of strategies to reduce these disparities. "Because the military health system provides comprehensive health insurance to a racially and ethnically diverse population of beneficiaries, studying disparities in healthcare treatments and outcomes among this population could add significantly to our understanding of the potential effect of universal coverage on reducing disparities in healthcare," the authors write.

Researchers analyzed data from 822,900 children ages 2 to 17 who were continuously enrolled throughout 2007 in TRICARE Prime, a Department of Defense HMO-type plan. Asthma prevalence, treatment patterns and outcomes were assessed among children ages 2 to 4, 5 to 10 and 11 to 17. Racial and ethnic differences were apparent in several measures and age groups. Black and Hispanic children were more likely to be diagnosed with asthma at all ages. Black children of all ages and Hispanic children ages 5 to 10 were more likely to have potentially avoidable hospitalizations or ED visits related to asthma.

According to the authors, "Our findings with regard to treatment patterns were mixed. Black children, who at all ages were more likely to have a diagnosis of asthma and to have poorer outcomes than white children, were also more likely to receive recommended asthma medications, especially inhaled corticosteroids." However, this could be related to the higher rates of ED visits and potentially avoidable hospitalizations among these children, as medications could have been prescribed and filled during or after these visits.

Black children were also less likely to receive care from a specialist, who may be more likely to treat asthma according to guidelines, including appropriate use of controller medications. "Thus, even though black children filled more prescriptions for asthma medications, they may have been less likely than white children who visited specialists to control their asthma and use the medications appropriately," said the authors. "Our findings suggest that eliminating racial and ethnic disparities in healthcare likely requires a multifaceted approach beyond universal health insurance coverage."

To learn more about this research, please visit:
http://pubs.ama-assn.org/media/2010a/0607.dtl#7

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Kaiser Strategies Reduce Inappropriate ER Use

When primary care isn't available, several proxy healthcare services can sometimes fill the bill for certain conditions, helping to reduce the number of avoidable ER visits, explains Sara Gray, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado. Ms. Gray describes two important steps hospitals can take when discharging patients to keep those patients from seeking post-discharge care in the ER, and suggests a hospital-SNF partnership to reduce preventable ER visits by SNF patients.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#119

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Two Ways to Improve Care Delivery in the Medical Home

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Michael Erikson, M.S.W., vice president of primary care services for Group Health Cooperative.

Question: Through your experiences at Group Health Cooperative, can you provide some steps in improving medical home care delivery?

Respons: First, call management was a necessary underpinning of the Group Health Cooperative PCMH. Prior to the work on our medical home pilot program, our delivery system was only about 9 percent capable of taking a call from a patient into our primary care practices and resolving that in the first call. For those patients whose call could not be resolved, it often took hours to days to get their answer to a simple question. Currently, all 26 medical centers can answer that patient’s call 80 percent of the time the first time they call, and no patient waits longer than 45 minutes for an answer to their clinical question.

The second strategy of our PCMH was to proactively use virtual medicine — secured messaging on the phone — to substantially improve care planning and connection with patients. We now have no less than two standard phone visits per day per physician, every day of the week. Patients can request and book a phone visit with their physician. Physicians can also request that the patient have a phone visit if there are lab results that need to be followed up on that require a direct conversation. We also wanted to use secure messaging for those patients who are activated on MyGroupHealth, which is our Web-enabled interaction with our patients. It’s a secure Web site that is connected to their EMR. They have a view of their EMR as well as e-mail correspondence to and from the physician, and become a part of that ongoing medical record. It was a way for the physician in the medical group to do much more proactive planning with patients.

For more strategies to improve medical home care delivery and healthcare savings, please visit:
http://store.hin.com/product.asp?itemid=4005

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

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There are other free email newsletters available from HIN!

Medical Home Monitor tracks the construction of medical homes around the country and their impact on healthcare access, quality, utilization and cost. As providers and payors reframe care delivery, this twice monthly e-newsletter will cover the pilots, practice transformations, tools and technology that will guide healthcare organizations toward clinical excellence.

To sign up for our free email newsletters, please visit:
http://www.hin.com/freenews2.html

Power of Patient Education

To paraphrase a commercial that was popular for years in the East, an educated consumer is the healthcare industry’s best customer. We wanted to measure the impact of patient education programs on health outcomes, medication adherence and healthcare cost and utilization.

Click here to view the chart.

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2010 Benchmarks in Obesity and Weight Management

This white paper captures organizations' top strategies to prevent and reduce obesity and related conditions and costs, based on responses from 131 healthcare organizations to the April 2010 Healthcare Intelligence Network Obesity and Weight Management e-survey.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registerobm10.html

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DM Could Have Reduced High Hospitalization Rates for Four Chronic Diseases

Four common and costly chronic conditions — diabetes, asthma, COPD and heart failure — are behind higher-than-average hospitalization rates in Pennsylvania hospitals — rates that "could have been avoided with lifestyle changes, earlier intervention and ongoing DM," according to Joe Martin, executive director of the Pennsylvania Health Care Cost Containment Council (PHC4).

The report found that Pennsylvania’s hospitalization rates for all four conditions were higher than the national rates for these conditions in both 2004 and 2007. Also, Pennsylvania’s hospitalization rates for three of the four conditions — diabetes, asthma and COPD — increased from 2004 to 2008.

According to the report, based on the average Medicare payment for each of these conditions, total Medicare payments for Pennsylvania hospitalizations for the four conditions in 2007 were estimated at $615 million. PHC4 estimated that if all payors paid at the Medicare rate, total payments for all hospitalizations for the four conditions would have totaled slightly more than $1 billion in 2007.

The report also found significant variations in hospitalization rates for the four conditions exist based on race/ethnicity. Black (non-Hispanic) residents tended to have higher rates than white (non-Hispanic) and Hispanic residents. Among Pennsylvania residents age 65 and older, approximately one in 24 white (non-Hispanic) residents were likely to be hospitalized for one of the four conditions in 2008, compared to one in 15 black (non-Hispanic) or Hispanic residents. Additionally, more than 25 percent of the individual patients admitted for any of the four conditions were readmitted to the hospital for the same condition within one year. Nearly 10 percent of these patients were readmitted more than once for the same condition.

To learn more about this research, please visit:
http://www.phc4.org/reports/chroniccare//10/nr061010.htm

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HRAs

Aggregate data from health risk assessments (HRAs) provides a roadmap for healthcare organizations to deliver health promotion and disease management interventions to targeted individuals — with the goal of improving clinical and financial outcomes. Join the more than 85 organizations that have already completed our survey on HRAs and get a FREE executive summary of the compiled results.

To participate in this survey and receive its results, please visit:
http://www.surveymonkey.com/s/healthrisks

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